P0905 - Empiric Platelet Transfusion in Acute Variceal Bleeding Is Associated With Higher Mortality and Rebleeding: A Systematic Review and Meta-Analysis

Ashesh Das, MBBS¹, Aarushi Gupta, ², Sunaisha Addanki, MBBS³, Kush Bharatbhai. Varsadiya, MBBS⁴, Aneek Ghosh, MBBS⁵, Adithya Chandran, MBBS⁶, Saketh Mehul Echampati, MBBS⁷, Venkata Dileep Kumar Veldi, MBBS⁸, Nisha S. Gowda, MBBS⁹, Deepak Venkataraman, MD¹⁰, Krishna Sai Kiran Sakalabaktula, MBBS¹¹, Krishiraj Kishor. Borse, MBBS¹², Noorin Riya T. S., MBBS¹³
1KPC Medical College and Hospital , Kolkata, India, Kolkata, West Bengal, India; 2Avalon University School of Medicine, Irvine, CA; 3Gandhi Medical College & Hospital, Secunderabad, India, Hyderabad, Telangana, India; 4Shri M. P. Shah Government Medical College, Surat, Gujarat, India; 5Nazareth Hospital, Philadelphia, PA, Kolkata, West Bengal, India; 6Indira Gandhi Medical College and Research Institute, Bangalore, Karnataka, India; 7SRM Medical College Hospital and Research Centre, Hyderabad, Telangana, India; 8Gayatri Vidya Parishad Institute of Health care and Medical Technology, Visakhapatnam, Andhra Pradesh, India; 9Gadag institute of medical science, Mysore, Karnataka, India; 10Davao Medical School Foundation Inc., Philippines, Houston, TX; 11Government General Hospital Kakinada, Kakinada, Andhra Pradesh, India; 12NAMO MEDICAL EDUCATION AND RESEARCH INSTITUTE, Daman, Daman and Diu, India; 13ALL INDIA INSTITUTE OF MEDICAL SCIENCE, Karupadanna, Kerala, India

Introduction: Acute variceal bleeding (AVB) is one of the leading causes of mortality in cirrhosis patients, having around a 20% mortality rate at 6 weeks. Although platelet transfusions are frequently performed to manage thrombocytopenia, they carry risks such as inflammation and fluid overload. Their efficacy associated with the transfusions is questionable. This systematic review and meta-analysis aim to assess whether providing patients with AVB platelet transfusions has any effect on mortality and rebleeding.

Methods: A systematic search of PubMed, Embase, Scopus, and Cochrane Library identified cohort studies reporting mortality outcomes at 42 days or 6 weeks after empirical platelet transfusion compared to management without transfusion for Acute Variceal Bleed. Data was analysed using RevMan 5.4. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using Mantel-Haenszel methods. Random- or fixed-effects models were applied based on heterogeneity (Higgins’ I²). Statistical significance was set at p < 0.05. Risk of bias was assessed with the Newcastle-Ottawa Scale (NOS).

Results: Three retrospective (two single-centre, one multicentre) studies met inclusion (n = 1,375; 175 transfused, 1,200 controls). Platelet transfusion was associated with significantly higher 42-day mortality: 32 % vs 14 % (pooled risk ratio = 4.22, 95 % CI 1.34–13.35, p = 0.01). All individual study estimates favoured no transfusion. Heterogeneity was high (I² = 91 %), driven mainly by a cohort in which transfusion occurred within massive-transfusion protocols; leave-one-out analysis reduced I² to 48 % while the harm signal persisted (RR = 2.38, 95 % CI 1.37–4.11). Biswas 2022 documented day 5/ 42 rebleeds of 14.3 % → 31.9 % vs 4.3 % → 13.3 % (propensity-matched HR 2.9) while Canakis 2020 reported failure-to-control bleeding at 5 days in 18 % vs 4 % with platelets.

Discussion: Existing evidence suggests that in AVB, empiric platelet transfusion gives no survival benefit and may increase short-term mortality by more than two-fold. Results from adequately powered RCTs will need to stratify by platelet count, bleeding severity, and portal hypertensive physiology before routine platelet replacement is performed under rigidly defined criteria. Until then, targeted vasoactive medications, early endoscopic procedures, and conservative packed red blood cell will remain to be the mainstay of treatment for managing AVB.


Figure: Forest Plot Showing Mortalilty at 42 Weeks for the 3 Studies


Figure: Prisma Flowchart

Disclosures:
Ashesh Das indicated no relevant financial relationships.
Aarushi Gupta indicated no relevant financial relationships.
Sunaisha Addanki indicated no relevant financial relationships.
Kush Varsadiya indicated no relevant financial relationships.
Aneek Ghosh indicated no relevant financial relationships.
Adithya Chandran indicated no relevant financial relationships.
Saketh Mehul Echampati indicated no relevant financial relationships.
Venkata Dileep Kumar Veldi indicated no relevant financial relationships.
Nisha Gowda indicated no relevant financial relationships.
Deepak Venkataraman indicated no relevant financial relationships.
Krishna Sai Kiran Sakalabaktula indicated no relevant financial relationships.
Krishiraj Borse indicated no relevant financial relationships.
Noorin Riya T. S. indicated no relevant financial relationships.

Ashesh Das, MBBS¹, Aarushi Gupta, ², Sunaisha Addanki, MBBS³, Kush Bharatbhai. Varsadiya, MBBS⁴, Aneek Ghosh, MBBS⁵, Adithya Chandran, MBBS⁶, Saketh Mehul Echampati, MBBS⁷, Venkata Dileep Kumar Veldi, MBBS⁸, Nisha S. Gowda, MBBS⁹, Deepak Venkataraman, MD¹⁰, Krishna Sai Kiran Sakalabaktula, MBBS¹¹, Krishiraj Kishor. Borse, MBBS¹², Noorin Riya T. S., MBBS¹³. P0905 - Empiric Platelet Transfusion in Acute Variceal Bleeding Is Associated With Higher Mortality and Rebleeding: A Systematic Review and Meta-Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.